Small Study Links Testosterone Therapy to Increased Anger in Transgender Men

Transgender men who undergo testosterone therapy as part of their female-to-male transition might experience more anger than they did before therapy, according to a new Journal of Sexual Medicine study.

Cross-sex hormone therapy, such as testosterone therapy, is a common treatment for individuals with gender dysphoria who wish to transition from their birth gender to their desired gender. In the process, secondary sex characteristics of the birth gender are suppressed, and those of the desired gender start to develop.

For transgender men, testosterone therapy is intended to bring hormone levels to the normal range for biological men. Eventually, facial and body hair grows or becomes more prominent, a more muscular build develops, and the voice may deepen. For some patients, menstruation ends, and the clitoris enlarges.

Past research has investigated testosterone levels and human aggression, but little was known about the such effects on transgender individuals.

The study involved 52 transgender men who had continuous gender-affirming testosterone therapy. Before treatment, and at least 7 months later, each participant completed the State-Trait Anger Expression Inventory-2 (STAXI-2), a validated questionnaire that assesses anger intensity, frequency, and control. Levels of testosterone and estradiol (estrogen) were also measured at these time points. Anthropometric traits, history of psychiatric disorders and pharmacologic treatments, and life events were assessed at baseline.

At the start of the study, about 62% of the participants had no Axis I or II disorders (e.g., mood, anxiety, and personality disorders), as described by the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV. After 7 months, all the transgender men had increased testosterone levels, with no significant changes in estradiol levels.

Forty-six percent had stopped having menstrual periods due to testosterone therapy; the rest still had regular bleedings.

STAXI-2 scores related to anger expression and anger control increased significantly between baseline and the follow-up point, although anger expression did not appear to be related to follow-up circulating testosterone levels.

Participants who had regular bleedings and Axis I disorders were more likely to express anger. None of the participants behaved aggressively, harmed themselves, or required psychiatric hospitalization.

Psychological support helped the transmen “prevent angry behaviors and decrease the level of dysphoria,” the authors wrote.

Although these findings are intriguing and thought provoking, experts in transgender health caution against drawing any firm conclusions from this study alone, given the small sample size and short time period studied. Experts recommend further studies with longer follow-up, larger sample sizes, and selection of samples that appropriately represent the broader transgender population.